Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA.
Colon and Rectal Surgery Clinic, University of Washington Medicine - Valley Medical Center, Renton, Washington, USA.
Colorectal Dis. 2022 Jan;24(1):111-119. doi: 10.1111/codi.15938. Epub 2021 Oct 18.
Robust data demonstrate that enhanced recovery protocols (ERPs) decrease length of stay, complications and cost. However, little is known about the reasons for variation in compliance with ERPs. The aim of this work was to confirm the efficacy of ERPs in a regional network, and to determine factors that are associated with ERP delivery in diverse hospital settings.
A prospective cohort of patients was created by recording all elective colorectal operations at hospitals in the Surgical Care Outcomes Assessment Program (SCOAP). The delivery of 12 ERP components was tracked at all sites, and factors associated with ERP component delivery and affecting outcomes were reported.
From 2016 to 2019, 9274 elective colorectal operations were performed at 36 hospitals. Indications were 48% cancer, 23% diverticulitis and 8% inflammatory bowel disease. Minimally invasive surgery was used in 71%. The proportion of cases with six or more ERP components received increased from 23% in 2016 to 50% in 2019. An increase in components was associated with a shorter length of stay and fewer combined adverse events and reinterventions. Further, increasing numbers of ERP components provided an incremental benefit to patients even when delivered in a low-volume centre or by a low-volume surgeon, and regardless of patient presentation.
At SCOAP hospitals, the delivery of increasing numbers of ERP components was associated with improved perioperative outcomes and decreased complications after elective colorectal surgery. The variation in delivery of these evidence-based components in subsets of our cohort indicates an important opportunity for quality improvement initiatives.
大量数据表明，加速康复方案（ERPs）可缩短住院时间、减少并发症并降低成本。然而，对于 ERPs 执行率存在差异的原因，我们知之甚少。本研究旨在确认 ERPs 在区域网络中的疗效，并确定在不同医院环境中与 ERPs 实施相关的因素。
通过在外科手术质量评估计划（SCOAP）的医院中记录所有择期结直肠手术，创建了一个前瞻性队列。在所有地点跟踪了 12 个 ERP 组件的实施情况，并报告了与 ERP 组件实施相关并影响结果的因素。
2016 年至 2019 年，在 36 家医院共进行了 9274 例择期结直肠手术。适应证为 48%的癌症、23%的憩室炎和 8%的炎症性肠病。微创手术的使用率为 71%。接受 6 个或更多 ERP 组件的病例比例从 2016 年的 23%增加到 2019 年的 50%。增加组件与住院时间缩短以及联合不良事件和再次干预减少相关。此外，即使在低容量中心或低容量外科医生处实施，并且无论患者的表现如何，增加 ERP 组件的数量都能为患者带来额外的益处。
在 SCOAP 医院，实施越来越多的 ERP 组件与择期结直肠手术后的围手术期结果改善和并发症减少相关。我们队列的亚组中这些基于证据的组件实施情况存在差异，这表明有重要的质量改进计划的机会。
